This condition occurs due to compression of the spinal cord in the cervical spine. It can occur due to compression from a number of different structures, and can present as an acute issue or slowly over a number of months or years.
When the spinal cord is compressed, it interrupts the nerve signals that are being carried through the spinal cord to the rest of the body. This presents with a combination of the following:
The cause of the spinal cord compression may be related to:
Patients will be examined carefully for signs of myelopathy. These include changes in reflexes, gait abnormalities, strength and size of muscles, numbness in the hands and fingers.
A combination of Xray, CT scan, and MRI scan are performed. These can be required for an accurate diagnosis, and are important if considering surgical intervention. MRI is used to give valuable information about the health of the spinal cord, as well as the cause of the compression. CT can assess if there is a calcified disc and is used if the patient is unable to have an MRI scan. Xray is used to show the overall alignment of the cervical spine, and this can lead to one surgery being recommended over another.
For patients who have mild symptoms, initial treatment should be non-surgical with regular follow up and clinical examination. However, education is important for people in this situation, as worsening of the symptoms should prompt a more urgent clinical review.
Non-surgical treatment is more aimed at managing the symptoms that lead to the presentation – eg. Pain being managed with a soft collar, anti-inflammatory medications, and physical therapy. Patients should also avoid high risk activities such as skiing, bike riding and contact sport. This is because there is a risk with a fall that the symptoms may acutely worsen.
Surgical management is used for patients with more severe symptoms, or for patients whose symptoms progress over time. Surgical treatment options vary depending on the cause of the compression, but all aim to remove the compression and allow more space for the spinal cord. Options for surgery include:
Despite appropriate and well executed surgery being performed, the symptoms of cervical myelopathy do not always resolve. The aim of the surgery is to prevent worsening of the symptoms rather than cure for the symptoms that have already presented. This is the reason for recommending surgery at an earlier stage than with other spinal conditions.